Mezhdumire. A report of neonatal resuscitation

November 17 is world prematurity Day. The feast of the surviving children, their parents and doctors. The correspondent of “Pravmir” Nastya Dmitrieva spent a day in intensive care of newborn babies to see the Department working on the border of life and death.

God is in these boxes

Children’s hand in a wedding ring

Life on a palm

I was panicking at the sight of the daughter – she was placed on the palm

Resuscitator Olga Babak: People often don’t understand why to save these children

Gloomy St. Petersburg morning. Lazily dragged the trolley from the metro station prospect VETERANOV. To go twenty minutes. Over this time to remember the classic images from American movies: the corridor rumbles a gurney with an unconscious man nearby, holding her, fleeing doctors, shouting to each other valuable information about the patient is transferred to the account “three” on the operating table, then someone anxiously say, “get him intubated!” and appoint twenty blocks of unknown drugs.

— The hospital who asked? — the background returns to reality. The hospital asked us. Exit. Metres in two hundred yards you can see the outline of a tall building. Children’s city hospital № 1 on the avant-garde, 14. Here is the largest in Europe the neonatal intensive care unit. It is this way.

In the lobby we were met by an older sister and long leads through the long corridors and passages in the 39 Department. Two cherished numbers, 39, for thousands of parents of Petersburg shall mean a secret code: a place where your child was saved. In the intensive care unit from all over the city bring their children prematurely born with severe malformations, birth injuries, those who according to the testimony from the first breath must fight for the right to life.

Finally climb on the third floor: came. The first thing that surprises, silence. No gurneys, cries and noise. No fuss. A wide bright corridor, deep in the hall with flowers, sofas and tables. Some of them are doctors, fill out forms. On the wall between the posts hanging electronic scoreboard summaries of all patients.

Calm and — I want to write “cozy” — but is in intensive care may be comfortable? My thoughts are like listening to a passing doctor:

— We are not in the intensive care unit for adults, right? Are not inanimate tiles on the walls, and once at home.

Precedes a long hallway a little recreation: a couch rests against the wall. On the wall are dozens of pictures of children and words of gratitude to doctors: “We are grateful to the head of Yulia Gorelik and all the doctors who participated in the treatment of our daughter. The treatment was for a long time and in several stages. Now Kate, she already goes”, “you can’t find such words that could Express my gratitude to our saviors!!!”, “Our son was born weighing 610 grams, 28 cm, is in a critical condition. This heavy and for us, the parents, period, doctors have found words of encouragement In this Department, staffed by professionals, a “bright” head”, “Thank you for life!”.

“Wall of support” was invented by parents whose children were once out in the 39th ward. Invented for parents, for those who only have to sit on this couch, in great anxiety and suspense.

No doctor here can’t give guarantees

Today, the whole day will be spent with Tatiana Nikolaevna Kuznetsova, doctor-resuscitator. It seems to me that Tatiana isn’t very happy additional load in the form of a journalist with a Notepad and a photographer, hung with equipment.

— No problem to annoy you or interfere with the operation. We will try to be invisible.

Smiles.

— Let me show you what and how we have arranged.

— Let’s.

39 the Department is the only intensive care unit in Russia, which occupies two floors. On each of the four posts: a huge room, stuffed with sophisticated equipment and kyosemi, like mini-MCS, sensors, wires, monitors with numbers. Double wall, sheltering from excessive noise, temperature, microclimate.

In kuvasaj, 7-8 for the post, are the little “astronauts” — premature babies, still travelling somewhere on the border worlds. Each incubator attached data: date of birth, date of admission to the intensive care unit, a list of diagnoses (someone he gains 4-6 names separated by commas). Name written in all children, names not given to everyone.

Each post four times per day cleaned and washed, four times Quartet and four times in the air.

Anyone who goes inside, even just to look at the indicators first have to process the special solution. If you want something to touch, to buttons on the monitors, the blanket on Cubase, solutions, and even one treatment. After the performed actions. If you need to get through fifteen seconds to go back again treated hands. Pretty quickly this procedure used, as a mandatory complex movement of dance. To the sharp smell of anti-bacterial liquid is also used: an integral part of the Interworld.

Simultaneously, the Department may take up to six dozen young patients.

The children are being watched by doctors. Plus the clock in the ward are nurses. Each under the control of three or four children. Tremendous burden: globally, one nurse has one child.

— What do our sisters, it’s amazing. During life it is necessary to erect the monument.

Doctors are divided on treating and duty. Duty work days, accept patients at night and on weekends, taking responsibility for the decisions that need to be taken here and now. Your doctor shift starts at 9 am. It doctor “leads” child: thinks the overall plan of treatment, building the strategy, communicates with parents, explain the situation to them.

— We do parents do not hide, do not assumption is false hope, but try to maintain. Talk about similar cases of statistics. No doctor here can’t give guarantees that all will be well. Threat to life is always there. Here he is, all indicators in norm. But in one second everything can change dramatically.

We go to the post. On the left wall three of the incubator under the same blankets with the stars. Triplets. Three brothers were born at 26 weeks gestation weighing just over 700 grams each. Boy in intensive care for a month. They’re still in kuvasaj, but is now breathing on his own: the first small victory. Weight less than 750 grams, the doctors called among themselves “ultramtramadol body weight”.

Of course, before today, I knew that premature infants are very small. But until you own eyes will not see, it is impossible to imagine how it. Tatiana lifts the covers, I look inside. Heart hoots and compressed.

— Now they each weigh more than a kilogram. Us adults may seem: what is the difference in 200 grams? But for them it is a huge way. Sometimes we over two hundred grams for months struggling.

The little patient, mahogany Tatiana Nikolaevna, weighed 420 grams.

Under the new law there are two parameters by which doctors determine the fetus in front of them or a child that is already man: the term of pregnancy 22 weeks and weight of 500 grams. At least one of these conditions must be observed that doctors had a chance to fool mother nature. Sometimes a child born with a weight of 400 grams, but on the 29th week of pregnancy, when the body is already relatively Mature, and the child is much more likely to survive. And sometimes, required 22 weeks, but too little body weight: at this stage, the medicine of such children can not go.

Premature children are not born ready for life: immature lungs, heart, intestines, are not ready to eat, his eyes unable to stand bright light. Required balanced food, silence, a certain level of oxygen, the most accurate movement and touch, dim lights.

The so-called disease survivors, the complications, which carry only premature infants is retinopathy — pathology of the retina, which can lead to complete blindness. Struggling with this ophthalmologists. If the pathology progresses, your doctor may decide to conduct laser retinal photocoagulation: a laser to cauterize the abnormal vessels. It happens that in one operation cauterize up to a thousand of microvessels to save the child’s eyesight.

Another common disease of preterm infants, bronchopulmonary dysplasia, abnormal development of the lungs. This requires additional oxygen: normal air child is not enough, he needs a much higher percentage of oxygen to support the systems and organs in satisfactory condition. Every year with severe dysplasia doctors face less and less, even in conventional hospitals there is a special substance, surfactant, which helps reduce the lung pathology.

— With our children, we, of course, go through fire, water and copper pipes.

Often the first five or six weeks of life premature infants have to move 2-3 serious operation. Little heroes, bravely maintaining the fight for the fight with infections and complications. But even without surgery and complex interventions these children have enough suffering: too thin, almost transparent skin remain painful scrapes from the patches that are attached to wires and tubes and sensors into the veins inserted several catheters for sampling. Even soft water, not alcohol-based antiseptic irritate the skin.

In 97 percent of cases of premature birth, intrauterine infection is to blame, triggering labor. It is not something innate, genetically determined. As a rule, the problem of prematurity face just young mothers who lead a healthy lifestyle. guilt from the mother of a premature baby is born along with her child. It is common history, anywhere in the world. What happens, terrible, terrible, this is something no parent was prepared.

And of course, moms are starting to dig in yourself: maybe, it was possible to do something different? Suddenly I had to go in the tram, and taxi? Or to go to a restaurant, not to get sick?

The person begins to blame themselves, relatives begin to look for blame around, they may have aggression towards the doctors too. This is the story of almost every family. Our hospital has a psychologist who helps moms and their families to understand that everything is not her fault, not her mistakes.

The nurse is preparing to feed the children. “Feed” is rather arbitrary: the majority of them receives the balanced food intravenously or via a gastric tube. Unit can suck artificial nutrient mix from a bottle through the nipple. Tube feeding is clockwork: every three hours. As soon as the mother appears in the office (often, it remains for 5-6 days in the hospital to recover his strength after a difficult birth or a cesarean), she is asked to pump breast milk and freeze it. Then nurses have the opportunity to add a few drops of breast milk in the “menu” of the patient. Not so much for feeding, how to stimulate the intestines to get used to the normal infant nutrition.

— Similar to blood banks in the West there are breast milk banks, where it has long been practiced. Then, even if mom has no milk, or the child is left without a mother, doctors can still add healing breast milk in the diet. We look forward to the appearance of such a Bank of breast milk in our country.

Also hourly rehabilitation (nurse clears mucus from the trachea and upper respiratory tract: mouth and nose), if not more frequent, and shifting kids to avoid bedsores. One or two times a day to take blood tests to accurately monitor important indicators.

Laboratory at the Department own?

— No, let’s get to another building.

Is a nurse?

Yes. The day it happens, so will nameguest. Someone once brought a pedometer, timed, got 16 miles per shift.

Look how cleverly, quickly and, I think, very deeply nurse Julia leads a thin tube in the mouth of a child. But he was not crying and did not resist, only slightly frowns.

He’s hurting?

— No. Frustrating Yes, annoying Yes, but not hurt.

Yes.

— You, too, are working day and night as the doctor on duty?

— How many days a month is usually six to eight?

Julia looked at me in surprise:

Less than eight I have never been. Maybe 10, and 12 to be. This is our second home, we are here to work and live.

12 days per month. Every day you’re constantly on the go, constantly moving from one child to another. If all is quiet, then you need to feed, sanitize, give medications, check the sensors, change the diapers, to add solution. “If everything is quiet” in intensive care is very rare.

“Today, take the pen”

In 2018 the intensive care unit on the avant-garde like a space station, modern equipment, a staff of specialists, computers.

To hour the parents begin to come. From one to three they have the opportunity to meet with a physician or head for conversation: ask questions, get status, get new information. A single mom entering the post Tatiana after greeting strictly says: “Today you take on the pens, remember?”. On the handle of the child can take some days, but my mom is afraid: too small, too fragile, too many things moved. Now her biggest task is to overcome this fear.

Here comes the mother of triplets, Natasha. Suited to each incubator, opens it, stroking a little something quietly and gently he whispers, watching as he sucks thumb and breathing evenly. This is not the first birth of Natasha, at home waiting for her 15-year-old son. Sister helps move a comfortable chair that Natasha was able to sit with the middle son in her arms, Pat his little back, hold on the chest.

Doctors strongly recommend that parents bring children woolen socks. Prickly wool is also a great stimulator of receptors, and on the heels of their most. Stimulation of neurons – tactile information in the brain of a child immediately starts to process, a good intellectual activity, exercise, contributing to the development. Here, the stimulants are the famous octopus knitted for premature babies: because of their long tentacles to grab and comfortable to hold. And fine motor skills is directly connected with the brain: it stimulates the communication between the nerve cells that forms the future intelligence.

The tactile quality of the equipment on the unit and sheep skins, which are spread children has already been transferred from the incubators to special tables and is able to independently maintain the desired body temperature.

His sons Natasha tiny socks tied herself:

— Could not but have learned, of course!

New socks together with a clean diaper, wipes and diapers Natasha puts in a special box under incubators. As a rule, all these things parents are buying for yourself. If a child without parents, then the necessary hygiene it provide the benefactors.

Refuseniks in recent years has become less. This is due, in particular, with the progress in the field of medicine: every year more and more challenging children, doctors manage to save, and death, and severe disability, one of the main reasons that mother’s written refusal. But “less” does not mean zero.

— Recently we received the girl, 580 grams. Mom rejected it immediately, in the nursing home, and never went back. And just a month ago, this girl checked out — and not in the child’s home left, and in the family home. took her to him. That’s the story.

On the couch sits a couple, Vitaliy and Alexander. Mom just got discharged from the hospital, she is still weak. They already had a daughter, now sat down to Alexander rested. In her hand she holds a piece of paper on which there is a list of documents for registration on the maternity ward. Prinimaya wife and embarrassed smile, Vitali says that his doctors he was glad for those five days, the girl removed one diagnosis and “say that positive dynamics”.

Parents, moms, dads, grandparents, will be here for another few hours. Nobody chases, asked to leave. Nurses move the chair to couveuses, and mom a long, long time quietly sitting with the kids on hand. Sometimes they come down to the hospital cafe to grab a bite to eat and return again for the post. If possible, be sure to meet with a specialist who explains to them that made or will make for their child.

We jokingly tell our parents, our children, and not their

In the hallway heard the alarming beeping of sensors, go for it. On one of the posts of doctor and nurse extabit baby: clean baby endotracheal tube, through which the ventilator the baby was breathing. The whole procedure lasts a few minutes. I don’t understand the values of the sensors on the monitors, but the sharp beeping and blinking red guided: most likely, something is wrong.

Doctor Sergey outwardly completely calm, confident voice. The nurse quickly and accurately produces manipulation. I was standing beside with bated breath. Finally the red lights stop blinking, the beeping of the sensors is terminated. All over, this child will now breathe on his own. The extubation was successful.

In medicine nothing is definite. Well, a sore throat, can be, according to the classical scheme is treated with antibiotics. But we have there is always one thing after another decisions: maybe, wait, maybe handle, maybe handle. To look ahead and understand to wait three days, or now to take him. A lot of the incoming data. Man is not a machine where stud left stud to the right turned, and it worked. Every rule has many exceptions, and there is something called experience and intuition of the doctor. And of course there are miracles.

Sometimes I feel that this woman with a scythe just standing next to, over his shoulder, and our child on the edge goes. But something is happening, something unknown to us, and we understand that this time she retreated.

When there is time and opportunity, the doctors have a rest in the treatment room. Ibid., if possible, sleep for a couple hours a day. Spacious kitchen, where doctors prepare yourself, comfortable sofas in the next room, bunk bed in hostels. Someone reading, someone watching TV. Near the door, a small sports area with weights, dumbbells.

Time almost five. Officially the change of Tatiana Nikolaevna ended half an hour ago, at 16:30. But she’s still here and leave, not seem. A huge part of the day is paperwork, the so-called status should be carefully and accurately describe all that has been patient for this day, all figures, analyses, numbers, appointments, changes of status.

— How you can take one status?

— If there was nothing urgent, just a stable current state, for about twenty minutes.

— And how many patients you have now?

Eight.

Count: if the minimum scenario on paper will take 160 minutes, 2 hours and a half. But “nothing urgent” too rare for reanimation.

— You always work late?

— Yes, constantly. For two or three hours is perfectly normal.

A personal Desk and computer Tatyana Nikolaevna as other doctors in the office, no. All the information is filled in two computers and turn in paper logs, sitting on the couch and leaning to the table.

— You know Anastasia, sometimes, we are the children of three or four months, and then they are transferred to the Department of pathology of newborns, can be observed in the hospital with specialists. But the beginning of the path was covered with us.

We remember these moms, we Pomnik diagnoses, grams of their children, where they lay in any box. This is our world, we live in it. We even jokingly tell parents that it is our children, not theirs.

But it happens that then the parents pass by and not know, not say Hello, eyes down. It hurt, of course, somewhere deep down. Understand that it is their psychological defense to forget, to erase the nightmare through which they have passed in intensive care. And cut out the people who are connected with it, that is, us doctors. Not because they are bad and ungrateful, but because this experience is too hard for them to make. Understand that, but it still hurts, Yes. Although, of course, not everybody looks the other way, no, there are parents who come to us after many years come to world prematurity Day, call, write, tell their kids grow up.

Remember all who are not saved

Tatiana Nikolaevna in intensive care since 2003. For fifteen years she had one major crisis when she left the profession.

— To the new law, a child weighing less than 1000 grams were considered a miscarriage, he had to live seven days to be recognized as a person to be recognized as alive. Prior to that, he was a fetus. And these “fruits” were born in a normal gynecological offices, even in hospitals. It was cold, it was not neonatology, not conditions. Birth trauma was like death. And it was a colossal disaster. And had plenty of things that you could not affect. At such moments, there came the despair.

As Tatiana Nikolaevna persuaded, then she wrote a statement and left. The first time I would say “well, I don’t care.” Gone into science, in a lecture, in a quiet pedes. Taught students, worked at the Department. Survived this year. Then I came back. And never went away.

At the beginning of the eighth, after a difficult six-hour operation on the vessel, bring another child. He’s in critical condition. Going around several people, doctors and nurses. Comes surgeon, tells in detail what she was doing, how was the operation. I don’t understand a word except for “venous” and “arterial”, but the persons reading that something was wrong. Call radiologists, confer, what and how of the drugs to give. So as not to disturb, we go next door, seen through the glass.

The doctors try one thing after another, constantly looking at the monitors, again, try, discuss. Doing the listening through a stethoscope, calculate on the calculator the right dose of medication. Again and again, look at the numbers. Finally something has shifted: the doctors smile. We are also exhaled. With questions not climb, but in snatches of conversation are aware that the night this child and the whole team will be difficult.

— Tatyana Nikolaevna, to the death you get used to it?

— No. We remember all of their patients who died in-person and by name even years later. On the fortieth anniversary of the branch coming doctors of retirement age, I’m sure they still remember all who are not saved. Every loss like a close friend. The first death I experienced is very difficult, although there once everything was clear, there was no chance. But always think what if? And still doing everything possible to save man.

And then, if not, infinitely begin to dig. We begin to blame yourself that somewhere something overlooked, not appreciated, and it would be necessary. This subjunctive is always present.

From self-destruction helps psychological assistance to senior colleagues, including his teammates, head. When they come, say, “This should have been done? Yes. Did you do that? Yes. You did everything you could”. The rest is uncontrollable, we are not gods.

Time goes to eight in the evening. Posts on the quiet, heard only the measuring signal sensors and persistent, a fine Creek one of the children. The small and weak do not shout — squeak like kittens, barely audible. And the cry is quite different: demanding and full of life. I’m ready to listen and listen. But to fit a child’s nurse and soothe him. The screaming stops.

Ahead of physicians on call a rough night. Around the tiny cot again gather almost all of the duty team. And once again the doctors and nurses will discourage the little boy from death. No one yet knows definitively whether.